So, Dr. Scholz, we're picking up questions from our YouTube comments section and somebody
was wondering what orgasms are going to look like after surgery vs. radiation?
They're wanting to make sure they maintain a good sex life here.
That's a good question.
I think that the default answer is that they're not supposed to change.
The possibility— or the capability of getting normal erections after treatment does often
change, unfortunately, but the general sense is that the, you know, the sensory nerves,
the things that lead to the experience of an orgasm, those nerves are not usually interrupted
by either surgery or radiation.
I wish I could tell people that's universally true.
It's not universally true.
There are people that have had issues with changes in their sensibility and their ability
to achieve orgasms after both surgery and radiation, but it's not the norm at all.
It's just like with anything— there are strange and unexpected occurrences with surgery
and radiation that happen.
I'm more concerned that they happen more frequently with surgery than with radiation, but I'm
not aware of any real good quality data that can tell us how often these things happen;
it's not very frequent though.
There's an 80-year old patient whose libido is not important to him, and so he's wondering
should he just get an orchiectomy and go ahead and just take care of it right away and not
go on hormone therapy so that—since it's not a big deal—is that just an okay procedure
to have?
Well, the irreversibility of orchiectomy, to me, is not a very attractive proposition,
though, it's not just libido that is impacted by having a low testosterone— it's bone
health, muscle strength, concentration skills, energy, all kinds of things—so, if there
is an opportunity for a man to get his testosterone back, I think in most cases that's going to
be desirable.
Can men that have had orchiectomy take testosterone?
And the answer is yes.
It's a bit more of a hassle than just having, you know, one's own testicles making your
testosterone—you can forget about it—but the people that do take testosterone—sometimes
Lupron shots cause permanent low levels of testosterone and even though these individuals
have stopped their Lupron, their testosterone isn't recovering which is very similar to
what happens if you have your testicles surgically removed which is what an orchiectomy is.
It is feasible to recover your testosterone, although people that have surgery are not
looking to recover testosterone, but I think it's wise to keep your options open, and I'm
not really a fan of orchiectomy.
So, there's a patient whose PSA was 84, and then they started taking Lupron and it went
down to about 18 in the past couple months, and it seems to be continuing [downwards].
Does this mean the cancer has stopped growing?
At least initially, it's likely that it has stopped growing.
The thing to look at in terms of predicting where things are and where things are going
to go in the future is something called the PSA nadir, and this is after a person has
been on hormone therapy for a period of 4-6 months, the PSA will generally bottom out
and if the PSA is higher than 0.1 which this individual clearly has a much higher level—we
don't know how long they've been on the treatment—but it doesn't look optimistic that they're going
to get all the way down to 0.1.
The typical PSA decline after even about 1 month is about 90%.
The concerns are very significant that it won't be long before the cancer growing, and
if it is regressing—the PSA is dropping—but there are cells in this individual, cancer
cells, that are still functioning and showing their metabolic activity by making PSA, and
that means that if they can do that, then they can grow.
So, it's an initial good sign, and it's almost always the case that you'll see an initial
drop in PSA when people start Lupron or any form of hormone therapy, but it's important
how far it goes; it's not just the initial response.
It's important people into what we call a complete remission; that means and undetectable
PSA, and studies show those people clearly do better than people who don't get into a
complete remission.
Thanks for watching.
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